Recurrent cystitis, do not surmedicalize: This article explores the topic in depth.
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Recurrent cystitis. Furthermore, do not surmedicalize:
Beyond the therapeutic management in the acute phase, the first step in the management of a cystitis consists in looking for the mechanism, at the origin of the infectious episode. Car “The occurrence of a urinary tract infection is only a symptom of a dysfunction of the urinary tree. In addition, underlines Dr. Meanwhile, Maxime Vallée. Consequently, urologist surgeon at the Poitiers University Hospital and manager of the Infectiology Committee of the French Association of Urology (AFU). Therefore, Any episode must therefore lead to seeking either a functional problem (in the vast majority of cases). In addition, or a congenital or acquired anatomical problem ”.
After having dismissed the possible presence of fever (in favor of an infection of the upper urinary system). Consequently, it is necessary to endeavor to reassure the patient and to understand her context recurrent cystitis, do not surmedicalize of life (history, profession, risk factors, etc.).
The interrogation must specify the symptoms and in particular the acute character. For example, If the symptoms appear chronically and persistently, without improving the quality of life under antibiotics, the diagnosis must be reviewed.
Likewise, the main symptom of a cystitis being the presence of per-medicated urethral burns, its absence must doubt the diagnosis. Meanwhile, On the other hand. Therefore, this symptom is not pathognomonic and can be present in other bladder pathologies and associated with other signs such as Pollakiuria, Urgenturia, Nycturia, Sus-Pubian pain at the end of urination, pyuria and hematuria. However, “Faced with these numerous symptoms, a diagnosis of recurrent bacterial cystitis can sometimes be made too quickly. It must be ensured that it is not a bladder hyperactivity or chronic bladder painful syndrome, for example … “ specifies the specialist.
The importance recurrent cystitis, do not surmedicalize of the missional catalog
The clinical examination is essential. The flowmetry and measurement of the post-mitional residue also, but the essential tool is the military catalog. It makes it possible to detect disorders acquired from urination. to propose a monitoring reprogramming and to do therapeutic education (urinary behavioral therapy).
The lack of diuresis is regularly highlighted. especially among young women who “retain” for lack of access to clean sanitary facilities …
« It does not exist in the repository literature for a definition of the normal, physiological milking catalog. However. the experience shows that the following criteria can be retained: the urination interval must not be more than 4 hours, the functional bladder capacity must not exceed 400 ml and total diuresis over 24 hours must not be less than 1.5 l “adds Dr. Maxime Vallée.
Restricted indications for antibiotic therapy
Antibiotics recurrent cystitis, do not surmedicalize have limited indications. “For example. if the explorations have not made it possible to highlight the cause, if the cause cannot be dealt with, or in the event of failure of care. Trator -prescribed antibiotic therapy can sometimes increase the risk of infectious. be the source of other bladder pathologies such as bladder hyperactivity or chronic bladder painful syndrome. »»
Cystitis is not a serious pathology and antibiotic treatment is only of interest to reduce the duration of symptoms. Their median duration is three days. the natural evolution of cystitis is the complete disappearance of the symptoms at ten days.
“In addition. in the event of a diagnostic doubt, a wait -and -see strategy is legitimate without major risk for the patient. Indeed. the risk of acute pyelonephritis secondary to untreated bacterial cystitis is low, less than 3 % of cases and favored by other underlying risk factors. recurrent cystitis, do not surmedicalize »»
TCU, a full -fledged treatment
Simple advice allows you to correct functional problems.
« Urinary behavioral therapy (TCU) should be considered a full -fledged treatment. The advice is personalized according to the military catalog in order to teach the patient to urinate in a physiological way (not to wait more than 4 hours. mormal volume over 24 hours of 1.5 l, etc.). The preliminary results of the Urica study. conducted in Poitiers, have shown that more than half of the patients consultant for “recurrent cystitis” had another diagnosis. And in case of functional cause. the TCU allowed a complete and lasting healing for more than 92 % of women ” underlines the urologist.
With regard to other alternatives, cranberry can be useful in certain situations. On the other hand. the d-mannosis has not shown an efficiency in a recent controlled, randomized study, published in recurrent cystitis, do not surmedicalize the Jama. Finally. vaccines (or rather an active immunoproprophylaxis), available in SUBLINGUAL SPRAY in certain countries, seem to be an interesting and promising perspective.
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